Listen for bruits (turbulent flow through the vessel) (you do this over the carotids as well); high pitched whooshing noise due to constricted blood flow through a tortuous vessel; shouldn't hear noise because normal laminar flow

Murmur = turbulent flow across a heart valve

Bruit = turbulent flow within a vessel (esp. artery)

Motivational interviewing steps

Provide opening structure

Ask open ended questions

Listen reflectively

Affirm

Identify motivators for/against 'problem behaviour'

Identify impact and implications of problematic behaviour on patient/others

Elicit self-motivational statements

Summarise key issues

Involve them in it: "from my point of view, losing weight by exercising/eating less is a good idea, what do you think?" "what small changes could you make?"

This gets them to tell themselves what to do.

Get them to talk about pros and cons

What is the worst thing that might happen if you don't change?

What has to happen to make you change?

What is the next change you need to make?

Tap into self-efficacy: "how have you been successful in the past?". Remind them that they've had successes in the past, and that it's possible for them to succeed again

Move from contemplation to action

Get them to come up with a goal and commit to it.

To assess self-efficacy, get them to reflect on the things that have made it difficult for them to change.

"Where did you see yourself being at this stage when you were young? How does this differ to how you are?"